Ankle Sprain

An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.

 

An ankle sprain is an injury to one or more of the ligaments that stabilize the ankle.
Reproduced from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Causes

Your foot can twist unexpectedly during many different activities, such as:

  • Walking or exercising on an uneven surface
  • Falling down
  • Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
  • During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.

Symptoms

Your foot can twist unexpectedly during many different activities, such as:

  • Walking or exercising on an uneven surface
  • Falling down
  • Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
  • During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.

 

Achilles Tendonitis

Achilles tendinitis is a common condition that causes pain along the back of the leg near the heel.

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration.

Causes

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:

A bone spur that has developed where the tendon attaches to the heel bone.
  • Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
  • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
  • Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.

Symptoms

Common symptoms of Achilles tendinitis include:

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Bone spur (insertional tendinitis)
  • Swelling that is present all the time and gets worse throughout the day with activity

If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

 

Flatfeet

You have flatfeet when the arches on the inside of your feet are flattened, allowing the entire soles of your feet to touch the floor when you stand up.

Illustration comparing normal and flatfeet footprints A normal arch leaves a footprint similar to the one depicted on the left, while flatfeet typically produces a footprint such as the one pictured on the right.

A common and usually painless condition, flatfeet can occur when the arches don’t develop during childhood. In other cases, flatfeet develop after an injury or from the simple wear-and-tear stresses of age.

Flatfeet can sometimes contribute to problems in your ankles and knees because the condition can alter the alignment of your legs. If you aren’t having pain, no treatment is usually necessary for flatfeet.

Symptoms

Most people have no signs or symptoms associated with flatfeet. But some people with flatfeet experience foot pain, particularly in the heel or arch area. Pain may worsen with activity. Swelling along the inside of the ankle can also occur.

 

Cavus Foot

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

cavus1

Causes


Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality.

An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

Symptoms

The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

  • Hammertoes (bent toes) or claw toes (toes clenched like a fist)
  • Calluses on the ball, side, or heel of the foot
  • Pain when standing or walking
  • An unstable foot due to the heel tilting inward, which can lead to ankle sprains

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

 

Plantar Fasciitis and Bone Spurs

Plantar Fasciitis is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.

Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.

Causes

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition:

  • Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
  • Obesity
  • Very high arch
  • Repetitive impact activity (running/sports)
  • New or increased activity

Heel Spurs

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Symptoms

The most common symptoms of plantar fasciitis include:

  • Pain on the bottom of the foot near the heel
  • Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
  • Greater pain after (not during) exercise or activity

 

Ankle Fracture

A broken ankle is also known as an ankle “fracture.” This means that one or more of the bones that make up the ankle joint are broken.

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months.

Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.

Broken ankles affect people of all ages. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of “baby boomers.”

Causes

  • Twisting or rotating your ankle
  • Rolling your ankle
  • Tripping or falling
  • Impact during a car accident

Symptoms

Because a severe ankle sprain can feel the same as a broken ankle, every ankle injury should be evaluated by a physician.

Common symptoms for a broken ankle include:

  • Immediate and severe pain
  • Swelling
  • Bruising
  • Tender to touch
  • Cannot put any weight on the injured foot
  • Deformity (“out of place”), particularly if the ankle joint is dislocated as well

 

Bone Bruise (heel)

Bone bruises—or bone contusions—are a type of traumatic injury to the bone that is less severe than a fracture and can occur when blood builds up within the different layers of the bone. Bone bruises are fairly common.

Causes

Bone bruises may occur in any bone in the body, though they are most common in ones closer to the surface of the skin. Thus, they occur more frequently in the ankle, knee, wrist, heel bone, foot, and hip, and normally follow a single traumatic event such as a car accident or sports injury. Bone bruises commonly occur due to a direct blow to the bone, two bones striking each other after the injury to a ligament, damage to nearby bones, and in some cases, medical conditions such as arthritis where the bones may grind against one another.

Note:  In an individual with Osteoarthritis, bone surfaces grind against each other and can lead to bone bruising.  (Since the treatment for the arthritis might involve injecting corticosteroids into a joint) One should be aware that,  although it is unusual, corticosteroid injections may, in some cases, cause bone bruising.

Symptoms

Bone contusions may appear along with a bruise on the surface of the skin and be accompanied by symptoms such as stiffness, swelling, tenderness, and pain that last longer than that of a normal bruise. Bone bruises may last anywhere from a few days up to a few months depending on their severity.

 

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